Department of Nephrology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, PR China.
Institute of Chronic Kidney Disease, Medical University, Ningbo, Zhejiang, PR China.
Ren Fail. 2024 Dec;46(2):2386146. doi: 10.1080/0886022X.2024.2386146. Epub 2024 Aug 1.
The significance of glomerular IgM deposit intensity in IgA Nephropathy (IgAN) remained ambiguous and requires further research. Patients with biopsy-proven IgAN in our hospital from January 2018 to May 2023 were recruited into this retrospective single-center study. Patients who presented with positive IgM deposit were included in IgM + cohort while patients with negative IgM deposit were included in IgM- cohort. Of the IgM+, patients whose IF intensity of IgM deposits exceeded 1+ formed IgM-H cohort while patients whose IF intensity of IgM deposits was equal to 1+ consisted IgM-L cohort. Pairwise comparisons were performed among these cohorts to determine clinical disparities, following the propensity score matching process. Among 982 IgAN patients, 539 patients presented with positive IgM deposit. The Kaplan-Meier analysis showed that the IgM deposit did not contribute adversely to the outcomes (eGFR decreased from the baseline ≥ 50% continuously or reached end-stage renal disease). However, the Cox regression analysis showed that increased intensity of IgM deposit was an independent risk factor ( = 0.03) in IgM+. The IgM-H exhibited more pronounced segmental glomerulosclerosis ( = 0.02) than the IgM-L, which may also be associated more directly with higher urine protein levels ( = 0.02). Moreover, our generalized linear mixed model demonstrated a remarkably higher urine albumin/creatinine ratio ( < 0.01) and serum creatinine ( = 0.04) levels as well as lower serum albumin ( < 0.01) level in IgM-H persistently during the 5-year follow-up. This study concluded that increased intensity of glomerular IgM deposits may contribute adversely to clinicopathologic presentation and outcome in those IgM + patients.
在 IgA 肾病 (IgAN) 中，肾小球 IgM 沉积强度的意义仍不明确，需要进一步研究。本回顾性单中心研究纳入了 2018 年 1 月至 2023 年 5 月在我院经肾活检证实为 IgAN 的患者。将免疫荧光（IF）检查中 IgM 沉积强度阳性的患者纳入 IgM+组，IgM 沉积强度阴性的患者纳入 IgM-组。在 IgM+组中，IF 强度超过 1+的患者归入 IgM-H 组，IF 强度等于 1+的归入 IgM-L 组。通过倾向性评分匹配，对这些组间进行比较，以确定临床差异。在 982 例 IgAN 患者中，539 例患者的 IgM 沉积呈阳性。Kaplan-Meier 分析显示 IgM 沉积并未对结局（eGFR 持续从基线下降≥50%或达到终末期肾病）产生不利影响。然而，Cox 回归分析显示，IgM+患者中 IgM 沉积强度增加是一个独立的危险因素（ = 0.03）。与 IgM-L 组相比，IgM-H 组的节段性肾小球硬化更为明显（ = 0.02），这可能也与更高的尿蛋白水平更直接相关（ = 0.02）。此外，我们的广义线性混合模型显示，在 5 年的随访期间，IgM-H 组的尿白蛋白/肌酐比值（ < 0.01）和血清肌酐（ = 0.04）水平显著更高，而血清白蛋白（ < 0.01）水平更低。该研究得出结论，肾小球 IgM 沉积强度增加可能会对 IgM+患者的临床病理表现和结局产生不利影响。
